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USMLE STEP2 Exam
Step2 (Page 7 )

Updated On: 30-Jan-2026
Page 7 of 149
PDF with 738 Questions

A 17-year-old girl is brought in by her parents because of their concerns about her weight loss. She is petite, and a normal weight for someone her height is 100 lbs, but she weighs 78 lbs. She reports menstrual irregularity. The patient believes she is obese. She does not believe she has a problem. Her mother reports that she found laxatives on her daughter's nightstand, and heard her vomiting in the bathroom yesterday after dinner.
Which of the following is the most likely diagnosis?

  1. bulimia nervosa
  2. pregnancy
  3. anorexia nervosa
  4. no diagnosis, normal presentation
  5. obesity

Answer(s): C

Explanation:

Anorexia nervosa is an eating disorder that predominantly affects women in their teens and in early adulthood. It is defined as refusal to maintain a minimal normal weight, at least 85% of that weight considered normal for that person's age and height, and a morbid preoccupation with feeling obese.
Common strategies to lose weight include avoidance of all fats and carbohydrates, self-induced vomiting, obsessive physical activity, and abuse of laxatives or diuretics or both. Despite apparent aversion to gaining weight, anorectics frequently take very special care in preparation and consumption of food and may delight in preparing gourmet feasts for others. Menstrual irregularity and amenorrhea are also commonly reported but are not essential factors in making the diagnosis. It is not yet clear whether such menstrual problems are simply secondary to starvation or whether they reflect a more pervasive endocrine dysfunction. Perhaps the most striking clinical feature of this disorder is the misperception of body image.
Regardless of the method of confrontation, including use of mirrors or photographs, sufferers see themselves as overweight. The patient often refuses to agree that there is any problem whatsoever.
Numerous factors, including developmental, family, endocrine, and gastrointestinal disturbances have been implicated in anorexia nervosa, but the etiology has yet to be clearly established. Most commonly, the course consists of a single episode followed by remission. Some patients may suffer a series of relapses and remissions. Mortality rates have been estimated to be as high as 20%.



A 17-year-old girl is brought in by her parents because of their concerns about her weight loss. She is petite, and a normal weight for someone her height is 100 lbs, but she weighs 78 lbs. She reports menstrual irregularity. The patient believes she is obese. She does not believe she has a problem. Her mother reports that she found laxatives on her daughter's nightstand, and heard her vomiting in the bathroom yesterday after dinner.
Which of the following is the best initial treatment?

  1. Have her return in 2 weeks for cognitive behavioral therapy.
  2. Initiate lithium as it often causes weight gain.
  3. Send her home telling her parents this is normal teen behavior.
  4. Start a prenatal vitamin.
  5. Admit her for inpatient psychiatric hospitalization.

Answer(s): E

Explanation:

Generally speaking, anorexic patients who are 20% or more below their expected weight for their height are recommended for inpatient programs. Inpatient programs for anorexia nervosa usually use a combination of a behavioral management approach, individual psychotherapy, family education and therapy, and in some cases psychotropic medications.



A 70-year-old man is brought to his primary care doctor by the man's son. According to his son, who had not seen his father for about a year, the father seemed to have some personality changes. He was no longer interested in his hobbies and seemed apathetic. He seemed to forget easily, and he repeatedly asked the same already answered questions. On at least two occasions, the father wandered out of the house and was found by neighbors, who thought he was confused. Which of the following is the most common cause of dementia in a 70-year-old man?

  1. Alzheimer's disease
  2. Pick's disease
  3. Parkinson's disease
  4. vascular dementia
  5. subcortical dementia

Answer(s): A

Explanation:

Alzheimer's disease is the most common form of dementia. Of persons with dementia, 5060% will have Alzheimer's. Vascular dementia is the second most common, accounting for about 1530% of dementias.



A 70-year-old man is brought to his primary care doctor by the man's son. According to his son, who had not seen his father for about a year, the father seemed to have some personality changes. He was no longer interested in his hobbies and seemed apathetic. He seemed to forget easily, and he repeatedly asked the same already answered questions. On at least two occasions, the father wandered out of the house and was found by neighbors, who thought he was confused. Considering the information learned thus far, which of the following medications would be the most appropriate treatment here?

  1. donepezil
  2. fluoxetine
  3. aspirin
  4. amitriptyline
  5. ginkgo biloba

Answer(s): A

Explanation:

Donepezil is a cholinesterase inhibitor used for the treatment of mild-to-moderate impairment in Alzheimer's disease. Fluoxetine is an SSRI antidepressant. Aspirin would decrease clotting. Amitriptyline is a tricyclic antidepressant and with its anticholinergic properties, it would worsen cognition. Ginkgo is an herbal medicine.



A 70-year-old man is brought to his primary care doctor by the man's son. According to his son, who had not seen his father for about a year, the father seemed to have some personality changes. He was no longer interested in his hobbies and seemed apathetic. He seemed to forget easily, and he repeatedly asked the same already answered questions. On at least two occasions, the father wandered out of the house and was found by neighbors, who thought he was confused. If this man had Pick's disease, where would the preponderance of pathology be found?

  1. cerebellum
  2. caudate nucleus
  3. hippocampus
  4. frontotemporal areas
  5. parietotemporal areas

Answer(s): D

Explanation:

Pathologic changes will be seen in the frontotemporal cortex in patients with Pick's disease. Alzheimer's disease, also a cortical dementia like Pick's, has pathologic changes in the parietotemporal areas.



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